The US Health Care System Needs Immigrants

By any objective measure, the United States doesn't train enough medical doctors to meet the nation's needs. That means graduates from other countries are needed. Aaron takes a look at foreign medical graduates, an essential element of America's health care system.

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John Green -- Executive Producer
Stan Muller -- Director, Producer
Aaron Carroll -- Writer
Mark Olsen – Graphics
Meredith Danko – Social Media

And the housekeeping:

[chrisf]

US med school is both massively expensive and sets limits on admission that are lower than physician demand. Seems like that would be the biggest cause of the low percentage of domestic trained doctors.

[corwin]

As someone who works in a clinical setting, I would argue we don't just need foreign docs. Large numbers of nurses, techs, and auxiliary services staff come from other countries as well

[pftburchell]

It’s because of how expensive college is. The price is way to high, we can’t just give grants. Colleges need to lower prices.

[johndean]

Thank you for making these videos. They are highly informative and always interesting.

[rebeccawiens]

Canada has a lot of foreign doctors. Some become doctors in their country of origin, some immigrate here as a child and then subsequently go to school to become a doctor so that they can provide a better life for themselves and their family. I have never doubted the competency of any foreign doctor or any foreign medical professional for that matter. The South African, other African, Chinese, Indian, and Carribean doctors I've come in contact with have all been wonderful.

[minasoliman]

I’m an American citizen born and raised, but I went to a Caribbean medical school. Granted I struggled in my Step scores and I am taking a Masters in Public Health, as well as doing research publications. But that’s just the thing. I have two strikes against me: non-competitive scores and foreign medical graduate (FMG). Today, the state of Missouri is trying to put to practice the new Assistant Physician Law. Also, I don’t mind working as a “Physician Assistant” until the time I get residency. And yet I am considered “not qualified” to work as an PA despite the nations need to work in underserved areas.

Did I also mention I also did all my rotations in the US?

The point is, I think it’s important to point out that FMGs are pressured to do research to be more competitive in residency applications. And because we have the FMG stigma, we also have to work twice as hard to “prove ourselves” in our rotations.

I did my mistakes in the USMLE, and I learned from them and I even finished even Step 3, an exam that caused tragedies for some residents to be kicked out. I am still passionate about practicing and seeing patients and I’m willing to pay more than 10 grand on my ERAS just to be able to get a few interviews in hope that one program takes me this March. Until then, I’m in limbo, and I am preparing for plan B and plan C, in case plan A doesn’t work for me.

Anyway, thank you for the video. I think the US government does not realize the important of residency and they do not seem willing to fund more hospitals to open up.

Also, one last hurdle. I’m a US citizen. Shouldn’t I be granted the opportunity to join the Armed Forces and serve my country in hopes that I get a residency. The answer is: only if you’re a domestic graduate, not an FMG. When I get into residency, then I can only contact them. So I’m stuck between a rock and a hard place. But if I get in this March, you’ll be hearing from me again with this slogan: don’t give up.

I hope that rings true for me, if not this yea (this is my third time applying), then maybe next year.

[camcat]

Wondering if the cost of US medical schools has something to do with this. My primary reason for not having any interest in medical school is that I'm not about to borrow $200K just for tuition. Being a primary care provider in a town of 30, 000 or less isn't going to pay that off on a reasonable timeline. This also might explain why we have such poor distribution of physicians in this country. Perhaps a video about paying for medical school is in order?

[pet]

Increasing residency slots is also needed to solve the shortage. There is no shortage of qualified applicants... just slots.

[missiworld]

I think something worth mentioning is that once you complete your residency in one country, you often cannot practice in other countries. So if your specialty isn't available in your home country, you already don't have the option of returning to that country after residency since they often won't accept your residency as meeting their requirements. If there was a better way to certify boards and residencies across all countries, then doctors would be more free to move to where they are most needed.

[deavir]

I am a FMG but not an immigrant. There are lots of us because US medical schools don't have enough spots. Calling us all immigrants is not accurate. Ross University alone places about 800 residents per year and most of them have US citizenship.

[BenVoyant]

Hey as a third SGU Med student, thank you for making this video. Hoping to go into primary care too haha

[DammedMan.]

Relying on migrant workers just sucks all the skilled workers from poorer countries.
Those poorer countries then have worse service.
This applies to more than just healthcare.

[MrsMagma]

One of the issues you didn't mention is brain drain, when countries like the US recruit highly skilled people (like doctors) from other countries, leaving their country of origin with a shortage of providers. Free movement of people is important and it is understandable to want to pursue 'The American Dream' and possibly make more money, but at some point it becomes a question of ethics.

[darkmage]

On the one hand, I agree that doctor shortages are a major problem, and that not enough people have the ability to see a doctor when needed. I live in Atlanta GA, and have friends who work in Grady Hospital - the lines to see a doctor are appallingly long, with some services requiring MONTHS of advance notice! And that's in the middle of one of the largest and busiest metropolises in the South; how bad must it be out in the middle of the Appalachian mountains?! We need more doctors and BADLY.

However, we must be very cautious in how we approach this: taken too far, rampant outsourcing can make it harder to get local people to become doctors due to lack of available positions preventing them from being able to pay back the massive loans they'd incur, which makes fewer people want to be doctors and necessitates more doctors being brought in to fill the gaps in a vicious cycle. We've seen this kind of thing adversely affect other industries such as software development; there's no reason it couldn't happen to medical practitioners, as well.

I'm not sure what the best solution is, here. Perhaps a small, short-term boost to immigrant doctors while also changing the education system to attract local medical students...?

[jamesbrobinson]

Could I ask you all to review and edit the captions for these videos? They are fantastic but my students with hearing loss struggle to use the resource. Thank you for all you do!

[Feinebea]

Just took USMLE Step 1 in Germany yesterday. You are welcome^^

[tristinfleurimond]

FINALLY SOME ONE FUCKING SAID IT, LOVE YOU MAN🎆🎆🎆

[LadyMordant]

Explains why I ask for a foreign trained doctor when I make a doctors appointment. They will get pissed when they hear that I’ve missed meds or have been withheld.
American trained will withhold my meds and tell me I will just get a little tired.
Took 4yrs when I was a kid before I saw a foreign trained doctor and we weren’t even in the room 5 minutes and he had me taken straight down to do tests. He was surprised I was moving around.

[GaviLazan]

Just a short note about the OECD stat regarding Israel- a large number of Soviet (and smaller number of European and American) Jewish doctors moved to Israel in the early 90s which contributed greatly to the 58%. In addition, in recent years there has been an influx of Israeli students who are studying medicine abroad - mostly in central and eastern Europe since it's easier to get into med school there and overall living/studying costs are similar or even lower than they are in Israel.

Both those push the "foreign medical grads" stats up, but also can mislead since they are Israeli citizens who merely studied abroad (in the more recent case) or are Jews who lived in the USSR and who fled to Israel after the fall of the Iron Curtain.

[MrSthotwhelz]

I can think of two instances off the top of my head where foreign trained professionals are prevented from practicing in the States unless they retook the same classes and certs. Kinda baffling.